DESCRIPTION OF THE STRATEGY

The origins of contingency management lie within the work of B. F. Skinner, the pioneer of
behavior analysis. In the early 1950s, Skinner proposed that the same learning principles used
as a paradigm for animal research could be adapted to human applications. By the mid 1960s,
behavior modification was applied to children with mental retardation, hyperactive behavior,
delinquency, and autism. These populations previously were thought of as resistant to
treatment, and the use of behavior modification greatly improved the quality of care for these
children. By the late 1960s, several texts regarding the application of contingency
management to education and parenting applications were published, and contingency
management has been a key feature of behavioral treatments targeting childhood disorders
since that time.
Contingency management can be defined as a process through which the reinforcement and
punishment of child behavior are assessed and the environment's responses to the child's
behavior (i.e., the contingency structure) are altered to effect behavior change. The dual
purpose of contingency management is to decrease maladaptive behavior and increase
adaptive behavior. Behaviorists suggest that a breakdown in the environmental contingency
structure underlies a child's maladaptive behavior or absence of appropriate behavior. The
goal, then, of contingency management is to restructure the child's environment to include
consistent consequences so that the child can learn how to behave appropriately as a result of
the new environmental structure. Intervention can target any aspect of the child's environment
but most often involves the child's home, school, and the clinic setting.
Contingency management can be a component of a larger treatment protocol or can be used
on its own to effect behavior change. One of the unique aspects of contingency management
is that the therapist can teach a number of individuals in the child's environment (parent,
teacher, sibling, peer, nurse, community volunteer) to serve as contingency managers.
Behavior therapists typically serve as consultants regarding children's behaviors, and
contingency managers (usually a parent or teacher) implement the plan under the advisement
of a therapist. The plan may include contingent rewards, punishment, or a combination of
these techniques. Older children may serve as their own contingency managers; however,
parents and teachers are more frequently chosen as the managers. The design and
implementation components most common to contingency management plans include (a)
reinforcement assessment, (b) measurement of the target behavior, (c) contingency
contracting, and (d) implementation of the contingency management plan.

Reinforcer Assessment
According to behavioral principles, reinforcement is key to the behavior change process.
Reinforcement can be defined as any response from the environment that increases the
probability of a behavior occurring in the future. Positive reinforcement occurs when the
probability of the desired behavior occurring in the future increases when something is added
to the environment (or an already present thing is increased). According to operant
conditioning, child behavior increases or is maintained as a function of positive reinforcement
provided to the child after performing the behavior. In contrast to positive reinforcement,
negative reinforcement occurs when something is removed from the environment (or an
already present thing is decreased) in order to increase an adaptive behavior. In addition, a
useful by-product of this method is that often the increase in adaptive behavior renders

incompatible undesirable behavior less likely (not to be confused with punishment, a process
applied directly to the undesirable behavior).
There are several selection issues that need to be taken into account when introducing a
reinforcer into the environment. First, it is important to select consequences that are of value
to the child, because not all stimuli and events are reinforcing to every child. Gender and
developmental level should be considered, as well as the child's individual preferences. For
example, what is reinforcing for a 6-year-old male (e.g., time playing games on a computer)
may not be what is reinforcing for a 14-year-old adolescent female (e.g., time talking on the
phone). Reinforcers must be individually based, as contingent consequences with no value to
the child will be ineffective in increasing behavior. In addition, because children's reinforcer
sensitivities can change, it is important to assess these preferences periodically. Booklets
listing sample reinforcers for different age ranges and different settings are available to assist
with reinforcer selection, as are structured reinforcer rating scales and menus. Second, the
therapist and contingency manager must determine the reinforcement schedule, that is, the
frequency with which the reinforcer will be delivered. Finally, the reward must be provided
contingent upon the performance of the target behavior. A reinforcer is most effective when it
is not available at any time other than following performance of an adaptive behavior.

Baseline Measurement
Assessment should be an ongoing process in the development and implementation of a
contingency management plan. The first step in developing any contingency management
program is to establish clearly which of the child's behaviors are targeted to increase or
decrease. Clear behavioral goals help the therapist and contingency manager determine
whether the child is on track and behaving appropriately. These goals can include the addition
of new behaviors to the child's repertoire, the increased frequency of already present positive
behavior, or the decreased frequency of already present negative behavior. A contingency
management plan also can target the reduction of negative parent or teacher behavior (e.g.,
criticism, authoritarian commands, attention to maladaptive child behavior). However, the
focus of this entry is on child behavior.
Accurate assessment of the baseline rate for maladaptive behavior, the intensity of the
behavior, and the naturally occurring environmental stimuli and reinforcers that serve to
maintain the maladaptive behavior is important for the design of the contingency management
plan. This assessment should be conducted at the beginning of therapy and should include a
thorough evaluation of the antecedents to the behavioral event, the nature of the behavior, and
the consequences of the child's behavior. Assessment methods can include parent report, child
self-report, child self-monitoring, and direct observation. A parent, teacher, trained observer,
or therapist can conduct direct observations of child behavior, and the resultant data should be
plotted on a behavior chart. This ongoing monitoring can serve as a motivator for the manager
and child as they document behavioral progress, but the monitoring is also practical in that it
can help determine when the goals of therapy have been met. In addition to the pretreatment
assessment, posttreatment and follow-up assessments are valuable tools for measuring the
maintenance of treatment gains.

Contingency Contracting
Contingency contracts can include behavioral contracts, daily report cards, and group
contingencies. Behavioral contracts are the most frequently used form of contingency

contracting. When designing a behavioral contract, the child and contingency manager agree
upon one or more specific behaviors to target. It is important for the child and manager to set
realistic goals and specific consequences, because if the goal is too large, the child will
become less motivated to work on the target behavior and the contract will fail. In addition to
agreeing upon the target behaviors, the dyad decides when the contract has been fulfilled and
what to do should the contract fail. Renegotiation may be needed if the terms of the contract
are met too easily or if the contract proves too difficult for the child.
Daily report cards can be used with children who have disruptive classroom behavior and
typically involve a child, parent, and teacher working together. Several target behaviors are
selected, phrased in positive terms (i.e., letting the child know what behaviors are expected),
and rated on their presence or absence during the school day by the teacher. If the child
performs the behavior during a specific time period, he or she receives positive feedback on
the daily report card. This report is sent home to the child's parent, who reads it, signs it, and
provides at-home rewards contingent upon demonstrated performance of the adaptive
classroom behavior. In addition to motivating a child to perform adaptive classroom behavior,
daily report cards can be a valuable communication tool between parents and teachers.
Group contingencies are especially useful in settings including more than one child
(classroom, sibling group, day care, extracurricular group). When using group contingencies,
the consequences (reinforcing or punishing) for group members depend on the behavior of
other members. For example, in consequence sharing, an entire group of children receives a
reward contingent on the good behavior of one child. Alternatively, interdependent group
contingency involves a group of children receiving a reward contingent on the good behavior
of the entire group.

Implementing the Contingency Management Plan

Manualized treatments are available for many parent-training protocols and are the gold
standard of contingency management training because they provide standard training that
includes identification of the behavioral concerns to be addressed and assessment of the
environment. The didactic training included in most manualized treatment provides the terms,
procedures, and goals of treatment. In conjunction with the manualized treatment, the
therapist monitors the execution of the program and provides frequent feedback about the
execution of the contingency management plan to the parent.
The use of a bug-in-the-ear microphone device also can enhance greatly the training of
contingency managers. The bug-in-the-ear device allows therapists to give directions to
parents while they play with their children, allowing parents in vivo practice of contingency
management techniques. This is an excellent training tool, as the therapist can direct the
parent in using reinforcement or punishment contingent on the behaviors displayed by the
child in session. Over time, parents learn to rely less and less on the therapist for direction as
their knowledge of contingency management application increases.
Contingency management can include a number of specific techniques (e.g., successive
approximations, selective attention, discrimination training, and extinction), but the most
frequently used techniques are contingent punishment, time-out, response cost, and
differential reinforcement of other behavior (DRO). Booklets that provide step-by-step
procedures for implementing these techniques are available to the interested reader.

RESEARCH BASIS
Contingency management is a hallmark of empirically based treatments for childhood
disorders. Specifically, research supports the use of contingency management for attentiondeficit/hyperactivity disorder, anxiety disorders, chronic pain, conduct disorder, depression,
distress due to medical procedures, encopresis, enuresis, obesity, oppositional defiant disorder,
phobias, and pervasive developmental disorders. Taken together, there is more research
evidence to support the efficacy of behavioral treatments of childhood disorders than any
other treatment modality.
Most evidence-based treatments for children with disruptive behavior problems (oppositional
defiant disorder, attention-deficit/hyperactivity disorder, and conduct disorder) involve parent
training, and research suggests that parents can be trained as successful contingency
managers. It is common for contingency management techniques to be imbedded in a larger
program such as parent management training (PMT), which typically targets processes such
as parent-child interactions and structuring the home environment. Research shows that PMT
programs that include contingency management as a component are the most effective
treatment modality for disruptive behavior disorders.
There has been a relative dearth of research focusing on measures that specifically assess
contingency management in the home. However, in-session techniques, such as in-session
drills, can be used to assess parental use and understanding of contingency management skills.
Successful completion of homework and in-session performance of skills can point to parental
understanding of contingency management.

RELEVANT TARGET POPULATIONS AND

EXCEPTIONS
Contingency management can be used to treat virtually any child population. It has been used
successfully with infants, young children, and adolescents. Contingency management has
been implemented with normal children to successfully increase intelligence, creativity, and
vocabulary. Children with physical disabilities, developmental delays, chronic illnesses,
learning disorders, communication disorders, behavioral problems, and emotional problems
have all been treated successfully with contingency management. Contingency management
has been used in a number of settings, including the home, classroom, workplace, medical
clinics, and in the community.
There are some populations that may not be appropriate for specific contingency management
techniques. For example, time-out is not an appropriate technique for children who engage in
self-stimulation behaviors, as they will find it reinforcing to sit by themselves on a time-out
chair. Also, most teenagers are too developmentally advanced for traditional time-out, so
techniques such as response cost or a behavioral contract are better contingency management
choices for this age group. Finally, parents who cannot understand the contingency
management plan (e.g., because of severe cognitive impairments) or who cannot consistently
implement the plan (e.g., because of individual psychopathology) may not be adequate
managers.

COMPLICATIONS

Some complications from contingency management techniques are possible. When parents
and teachers serve as contingency managers, consequences can become ineffective if they are
not consistently implemented in accordance with behavioral principles. For this reason it is
helpful for families to work with a behavior therapist initially to decrease the likelihood of
complications. Time-out is one technique that parents often have difficulty implementing
without the help of a behavior therapist. For example, parents often make time-out too long
for children. When this happens, the child may have difficulty staying on the chair and the
parent may decide that time-out does not work. Another common time-out mistake is when
parents talk to the child when the child is on the timeout chair. Unfortunately, popular media
sources such as parenting magazines often provide erroneous advice regarding the purpose of
time-out (e.g., it is a time to reason with the child), and contingency managers may have
difficulty obtaining behavior change if they rely solely on these sources.
Another contingency management complication may arise from using punishment when a less
aversive method (extinction, DRO, cognitive therapy techniques) is available and more
appropriate. Punishment can have unintended side effects that include avoidance behavior on
the part of the child. For example, a child may lie about a behavioral event in order to avoid
the contingent punishment that would follow if the manager were to learn that the child
performed a maladaptive behavior. Thus, lying could be a side effect of a contingency
management plan.
Finally, some techniques (e.g., extinction) will cause a temporary increase in the maladaptive
behavior (i.e., extinction burst) as the child reacts to the new contingency structure in the
environment. Parents may fail to persist with the treatment as the child's increased behavior
problems become too aversive for them.

CASE ILLUSTRATION
Samuel was a 5-year-old boy referred by his mother, Ms. M., to a university-based
outpatient clinic for the treatment of disruptive behavior problems. At the time of intake,
Samuel exhibited severe noncompliance, verbal aggression, and physical aggression toward
his parents, siblings, and peers. The severity of his behavior problems had resulted in
Samuel's expulsion from one day care program, and he was close to being released from a
second program.
The therapist completed a comprehensive assessment of the presenting problems that included
a clinical interview, parent and teacher reports of Samuel's behavioral functioning on
standardized behavior rating scales, and a behavioral observation of Samuel's interactions
with his mother in the clinic. The assessment revealed that Samuel's disruptive behaviors were
in the clinical range on standardized measures. In addition, the therapist observed a pattern of
interactions between Samuel and his mother that was consistent with the pattern frequently
observed between parents and their children with disruptive behavior disorders: (a) Samuel's
mother intermittently reinforced Samuel's negative behaviors (e.g., giving in to his demands
during tantrums), (b) she infrequently reinforced Samuel's positive behavior (e.g., ignoring
him when he complied with a direction), and (c) Samuel used increasingly aversive behaviors
(e.g., whining, then crying, then hitting) as a means to escape demands placed on him by
caregivers.
Samuel and his mother were referred for parent-child interaction therapy (PCIT), a behavioral
family intervention developed to reduce young children's disruptive behaviors, increase their

adaptive behaviors, and increase the effective use of contingency management strategies by
parents. During the first phase of treatment, the therapist and Ms. M. set specific behavioral
goals for Samuel and for herself. Ms. M. was taught to use selective attention to increase
Samuel's adaptive behaviors. Through didactic and in vivo coaching, Ms. M. increased her
social reinforcement of Samuel's positive behavior (e.g., labeled praise) and used strategic
ignoring of negative behaviors intended to get her attention. To assist with skill
generalization, Ms. M. practiced these strategies in daily interactions with Samuel. Weekly
assessment of Samuel's behaviors by parent report and therapist observation revealed a
decrease in attention-seeking behaviors (e.g., whining) but no decrease in incidents of
aggression. During the second phase of treatment, Ms. M. was taught to use time-out in a
consistent manner appropriate for a 5-year-old child. In the clinic, the therapist coached Ms.
M. in the use of negative reinforcement to increase Samuel's compliance with time-out. As
Ms. M.'s skills and Samuel's compliance increased, Ms. M. required less direction from the
therapist. To facilitate the development of Samuel's adaptive behavior, the therapist consulted
with Samuel's day care to implement the behavior plan already being implemented in the
clinic and at home. At treatment termination, Samuel's disruptive behaviors had moved from
the clinical range to within the normal range compared to other children his age. Ms. M.
demonstrated consistent use of positive reinforcement for Samuel's adaptive behavior, clear
and consistent use of negative punishment (e.g., removal of privileges contingent on the
occurrence of targeted undesirable behavior), and consistent use of time-out.
Elizabeth V. Brestan, Miranda Loeper, and Larissa N. Niec
Further Reading

Entry Citation:
Brestan, Elizabeth V., Miranda Loeper, and Larissa N. Niec. "Contingency Management."
Encyclopedia of Behavior Modification and Cognitive Behavior Therapy. 2007. SAGE
Publications. 15 Apr. 2008. <http://sage-ereference.com/cbt/Article_n2032.html>.